Youth MHFA Registration Form

Youth Mental Health First Aid Registration

Complete form below to sign up for the workshop.
YMHFA will be held at Jewish Family Services and led by the JFS Community Mental Health Liaison.

Location:
Community Services Building, Board Room
333 Bloomfield Ave.
West Hartford, CT 06117
Questions? Please reach out to Anna MacDonald, LMSW, Community Mental Health Liaison at amacdonald@jfshartford.org.
Name*

First NameLast Name
E-mail*
example@example.com
Company
Fill out this box if you are registering with your organization.
Are you over 18?*

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Which session will you attend?*

Wednesday, November 20 from 9am-3pm
How did you learn about this course?
Workshop registration: Please note, the first 5 people to sign up receive tuition at no cost (we will reimburse). Please reach out to Anna at amacdonald@jfshartford.org if cost is a barrier. *
prevnext( X )
Workshop Registration: Youth Mental Health First Aid Training
$25.00 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Youth Mental Health First Aid Registration